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Member Practice Update

20 March 2019

Welcome to the Member Practice Update

This weekly Member Practice Update is produced by NHS Redditch and Bromsgrove, NHS South Worcestershire and NHS Wyre Forest Clinical Commissioning Groups for circulation in your practice, to provide you with essential guidance, information and useful support.

Your views and feedback are very much appreciated. If you have any comments, suggestions or contributions for inclusion in the Member Practice Bulletin, please e-mail the communications team.

In this issue:

Find out about local and national events and training here.

  • No Redditch & Bromsgrove news 
  • No specific South Worcestershire news
  • No specific Wyre Forest news 

Primary Care Networks: Supporting the development of primary care networks  

On 26 March 2019 from 8-9pm Dr Nikki Kanani, Medical Director of Primary Care at NHS England, will be hosting a tweet chat about all things relating to Primary Care Networks. You can raise questions yourself on Twitter on the night using the hashtag #primarycarenetworks

Email england.PCN@nhs.net if you'd like any further details.

GP Forward View – Workforce – Physician Associates  

Health Education England has launched a campaign to showcase the benefits of employing a physician associate in general practice.

Physician associates (PAs) are healthcare professionals who are trained in the medical model and can complement the work of GPs and the wider practice team. Watch this video for more information.

Download a partner pack here.

GP Forward View – GP Portfolio role opportunity – DMC Healthcare 

Further to the various portfolio role opportunities we have shared over the past few weeks as part of our local STP GP retention scheme, we are really pleased to share a further opportunity with you on behalf of DMC Healthcare. The closing date for expressions of interest for this additional role will be Wednesday 27 March 2019.

Download the Job Plan if you are interested, please review and complete the Expression of Interest form by the date above. 

If you have any questions regarding the role or would like to submit an expression of interest, please e-mail the Herefordshire and Worcestershire Primary Care Workforce Team on sowoccg.workforce@nhs.net. Interviews and appointment to the roles will take place directly by the Providers

GP Forward View – Worcestershire Nurse Forum Feedback and Agenda 

Nina Lealan, Practice Nurse Clinical Lead for Worcestershire has been in post for the last twelve months and has been working on the following;

  • Supported and increased the number of pre-registration placements in general practice by working closely with the General Practice Nurse Mentors and University.
  • Delivery of the GPN 10 Point Plan
  • Working alongside the Practice Nurse Facilitator the PN Lead has supported an increase in nursing placements – from 2016 there were 6 Worcestershire placements, we now have 21.
  • Improve access to education and ‘return to work’ programmes – working closely with the Training Hub to standardise training at a high quality and reduced cost by organising training ‘at scale’ including; Phlebotomy and Accredited Diabetic training.
    Development of the Countywide Practice Nurse Forum – increased membership, provided clinical education, and support for practice nurses.
  • Responding to Practice Nurse queries including clinical and education queries.
  • Heightened the awareness of practice nurses looking for locum shifts on days off, holidays and practice managers requesting ANPs, PNs and HCAs cover for holiday and sickness.
  • Worked with The Training Hub who have launched a free service to support practices advertising their vacancies outside the county and within the local area to encourage applicants that are not currently in the STP to apply, aiding the recruitment process, whilst retaining existing staff across the county who may have skills which could be utilised in other positions such as locum and temporary contract work.

After each nurse forum, Nina collects feedback from the nurses and shares this with the CCGs and LMC. We thought practices would find it useful to have a summary of the feedback. Download a summary of the feedback from the February nurse forum here.

Below are some comments from nurses regarding the forum and Nina’s role;

  • ‘Very good - nurses need to share Knowledge and practice’
  • ‘Supportive, enthusiastic group - keep it going!’
  • ‘It must continue for networking and education for PN's across the county. It is really essential and Nina is excellent’
  • ‘This is a very well attended informative group. It is needed to keep professionalism in Nursing in Worcestershire.’

The next Worcestershire Nurse Forum will take place on 29 March at The Simply Limitless Well Being Centre for Wyre Forest, Kidderminster, DY11 5DF from 12.30-4.15pm.

Places are limited, so please ensure that you book your place as soon as possible via the Training Hub (see Agenda). When booking, please state any dietary requirements.

View the agenda.

Flash Glucose Monitoring (FlashGM, specifically Freestyle Libre®) 

In line with national guidance, arrangements for accessing FlashGM in Worcestershire will be confirmed by 1st April 2019. These arrangements make provision for consideration of appropriate patients at annual diabetes review and subsequently involve assessment and review of eligibility by diabetes specialist nurses. This means that patients will not be able to access FlashGM sensors immediately from 1st April 2019 and that general practice should not initiate any prescriptions for sensors until they receive notification from secondary care diabetology specialists (including adult or paediatric nurses).

This link provides further detail of the anticipated arrangements.

New Lifestyle Offer 

The current Living Well service contract (delivered by the Independence Trust) is ending on 31st March 2019. Over the years Worcestershire's lifestyle services have often struggled to engage fully with Primary Care to receive the number of referrals required to support those most in need.

Moving forward Public Health wish to work with the CCG to create a lifestyle offer that is more embedded within Primary Care as part of a wider integrated wellbeing offer. Public Health recently carried out some consultation through the neighbourhood team meetings to gain views on the current service and how a new model could be developed that is better at meeting the needs of those working in Primary Care and their patients.

For effective lifestyle services, PHE suggest the emphasis should be on the need to address the whole of the social determinants pathway in which psychosocial pathways are situated, supporting the need for more of an integrated wellness service which works closely with a social prescribing offer. In line with recent LTP developments, it is hoped that the lifestyle service will work alongside social prescribing and have a presence within each Primary Care Network.

Public Health and the CCG will be holding a workshop in May to support the development and implementation of a new lifestyle offer within Primary Care. We hope to gain views of GP's and practice managers about the most effective methods of integrating with the Primary Care Networks. If you are interested in being part of this discussion and would like to be notified of the workshop date, please contact  steven.connelly1@nhs.net.

Updated Flow Chart for Driving Post Stroke/TIA  

For your information, please download a copy of revised flow chart that will be given to patients by the Community Stroke Team regarding returning to driving following a stroke.

Prescribing Top Tips 

Salbutamol nebuliser solutions are commonly prescribed as pre-diluted 2.5mg/2.5ml or 5mg/2.5ml nebules. Several different brands are available (e.g. Ventolin® & Salamol Steri-Neb®) and these products account for the vast majority of nebuliser solution prescribing.

These products should not however be confused with salbutamol 5mg/ml nebuliser liquid. This is available as a proprietary preparation, Ventolin® Respirator Solution.  This product is more suited to use in hospitals, and whilst it can be given undiluted in exceptional clinical circumstances, it is usually necessary to dilute the solution with saline.  The Ventolin® Respirator solution SPC states:

“0.5 ml (2.5 mg of salbutamol) should be diluted to a final volume of 2 ml with sterile normal saline. This may be increased to 1 ml (5 mg of salbutamol) diluted to a final volume of 2.5 ml”

Erroneous prescribing of this product could result in patients using inappropriately high doses of salbutamol. In a recent incident, a patient was prescribed this product with insufficient information given by either prescriber or dispenser on dosage or dilution. The patient then used the undiluted solution in the nebuliser and they consequentially suffered severe palpitations and dizziness.

Practices should therefore be mindful that the correct, intended nebuliser solution is selected on the EMIS system and that the patient is aware of how to use the product.

If you have any suggestions for inclusion in the 'Top Tips' then please send them to akingham@nhs.net

World TB Day – March 24th 2019  

World TB Day falls on the 24th March every year and marks the day, in 1882, when Dr. Robert Koch identified the bacteria that cause tuberculosis (TB). His ground-breaking research opened the way towards diagnosing and curing this disease.

Worcestershire is classed as a low incidence area for TB, however we do see cases presenting to hospital or to their GP with the symptoms of TB. It is important to recognise the symptoms of TB (see flyer) as early as possible.

If a patient has the following symptoms think of TB: a cough which lasts more than 3 weeks, haemoptysis, weight loss, fever or night sweats, fatigue or tiredness, non-resolving swollen glands or loss of appetite.
If you think a patient may have TB please contact the TB Nursing Team on 01562 512316 (ex. 53137) or email: wah-tr.tbnursingteam@nhs.net

This leaflet will be sent to practices as part of the awareness week alongside a poster for Clinicians to signpost them to TB Services. Please can the leaflets  be displayed within the practice and the poster / contact details for the TB Team be distributed to clinicians. Further copies of the leaflet  are available via the CCG Comms Team.


Free online TB training for primary care professionals has been developed by the RCGP, TB Alert and PHE, with partner funding provided by NHSE. The training is accredited through the RCGP credit-based system for CPD and complies with NICE guidelines. The training is available via:www.elearning.rcgp.org.uk/tb

The below links have further information:

Strength and Balance classes for Falls Prevention 

The current contract for the delivery of Strength and Balance classes ends on 31st September 2019 and a new service will begin on 1st October 2019. Therefore, please note that as of 1st May 2019 there will be no new Strength and Balance classes set up. This will ensure that all classes that begin under the current contract will have been completed by 1st October. 

We will continue to accept referrals ahead of the new contract beginning on 1st October 2019. All participants will be contacted and informed of this arrangement.

If you have any questions, please get in contact with Sports Partnership Herefordshire and Worcestershire on 01905 855498 or email Worcestershire County Council.

St Richard's Hospice - Support Sessions  

St Richard’s Hospice has started a new free initiative for people with a serious progressive illness & their carers. They are running monthly social and information groups giving the chance to meet others in a similar situation, relax, have fun or learn skills to help manage an illness. All sessions take place from 3.30 – 4.30pm in the lovely, bright, modern redeveloped rooms at St Richard’s Hospice, Wildwood Drive, Worcester.

Understanding Pain and its Management; Love Books; Knit and Natter and Making your life easier with technology sessions are all bookable now for March and April dates. There is no need for a referral or for individuals to already be under the care of St Richard’s to attend. St Richard’s current patients and carers are also welcome.


  • 21 March:  Knit & Natter
  • 3 April: Making your life easier with technology
  • 4 April: Love Books
  • 23 April: Understanding Pain and its Management – an introduction

St Richard’s asks that individuals coming to the group are independent or can be independent with the support of a family member or friend.

These are group sessions and will not include one-to-one medical advice or have clinical support available.

Individuals can pre-book online or call the pre-booking message line 01905 760900.